Soergel Philipp, Kirschke Johanna, Klapdor Rüdiger, Derlin Thorsten, Hillemanns Peter, Hertel Hermann
Department of Obstetrics and Gynaecology, Hannover Medical School, Hannover, Germany.
Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany.
Lasers Surg Med. 2018 Dec;50(10):994-1001. doi: 10.1002/lsm.22999. Epub 2018 Jul 3.
Sentinel diagnostic in cervical cancer is performed using Technetium-99m-nanocolloid as a radioactive marker with or without patent blue. In the last years, indocyanine green has been evaluated for sentinel diagnostic in different tumor entities. Indocyanine green is a fluorescent molecule which emits a light signal in the near infrared band after excitation. Our study aims to evaluate indocyanine green compared to the gold standard Tc-99m-nanocolloid.
We included patients with early cervical cancer up to FIGO stage IIA with clinically node-negative pelvic sites and the indication for nodal staging in this prospective trial. Sentinel diagnostic was carried out using Tc-99m-nanocolloid, indocyanine green and patent blue. We examined each pelvic site for light signals from the near infrared band, for radioactivity and for blue staining. A sentinel lymph node was defined as a Tc-99m-nanocolloid positive lymph node. All sentinel lymph nodes and all additional blue or fluorescent lymph nodes were excised and tested; then sent to histologic examination.
Thirty-three patients were included in which we found 211 Tc-99m-nanocolloid-positive sentinel lymph nodes in 66 pelvic sites. Two hundred and seven of these lymph nodes were positive for indocyanine green, too, giving a sensitivity of 98.1% (95%CI 94.9-99.4%) compared to Tc-99m-nanocolloid. One hundred and sixty additional lymph nodes showed indocyanine green fluorescence but no Tc-99m-positivity, so that the sensitivity was 79.6% (95%CI 76.6-82.3%). In one patient, a pelvic site was only identified to be tumor infiltrated due to an ICG-positive, but Tc-99m-negative lymph node.
Our results show that indocyanine green is a promising approach for pelvic sentinel identification in cervical cancer. ICG has a similar sensitivity as radioactive Tc-99m-nanocolloid and may enhance both patient safety and surgeons' comfort. Lasers Surg. Med. 50:994-1001, 2018. © 2018 Wiley Periodicals, Inc.
宫颈癌前哨诊断采用锝-99m纳米胶体作为放射性标记物，可加用或不加用专利蓝。近年来，吲哚菁绿已被用于评估不同肿瘤实体的前哨诊断。吲哚菁绿是一种荧光分子，激发后在近红外波段发出光信号。我们的研究旨在将吲哚菁绿与金标准锝-99m纳米胶体进行比较评估。
在这项前瞻性试验中，我们纳入了国际妇产科联盟（FIGO）分期为IIA期及以下的早期宫颈癌患者，其盆腔部位临床淋巴结阴性且有淋巴结分期指征。采用锝-99m纳米胶体、吲哚菁绿和专利蓝进行前哨诊断。我们检查每个盆腔部位是否有来自近红外波段的光信号、放射性和蓝色染色。前哨淋巴结定义为锝-99m纳米胶体阳性淋巴结。所有前哨淋巴结以及所有额外的蓝色或荧光淋巴结均被切除并进行检测，然后送去做组织学检查。
纳入33例患者，我们在66个盆腔部位发现了211个锝-99m纳米胶体阳性前哨淋巴结。其中207个淋巴结吲哚菁绿也呈阳性，与锝-99m纳米胶体相比，灵敏度为98.1%（95%可信区间94.9 - 99.4%）。另有160个淋巴结显示吲哚菁绿荧光但锝-99m阴性，因此灵敏度为79.6%（95%可信区间76.6 - 82.3%）。在1例患者中，一个盆腔部位仅因一个吲哚菁绿阳性但锝-99m阴性的淋巴结而被确定为肿瘤浸润。
我们的结果表明，吲哚菁绿是宫颈癌盆腔前哨识别的一种有前景的方法。吲哚菁绿与放射性锝-99m纳米胶体具有相似的灵敏度，并且可能提高患者安全性和外科医生的舒适度。《激光外科与医学》50:994 - 1001，2018年。©2018威利期刊公司。
